Request Counseling for a Child

Do you have a child in your care who has experienced abuse, neglect, or sexual assault? Counseling at Foothills can give them tools to help them cope and begin to heal. Please fill out the form below to request counseling for a child in your care.

Child Counseling Request

Caregiver's Name

First Name

Last Name

Phone

(###)

###

####

Email

Child's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Has your child been seen at the Foothills Alliance Child Advocacy Center?

Yes

No

What type of abuse has your child experienced?

check all that apply

physical abuse

neglect

sexual assault

Please note: if you are requesting counseling for a person age 17 or under who has experienced abuse, assault, or neglect, and those experiences have not already been reported to Law Enforcement or DSS, First Light employees are required to report those experiences. You can learn more about our confidentiality and mandatory reporting policies here.

Request Counseling for a Child

FIRST LIGHT